POS0282 PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS (JIA) ON INTENSIVE TREATMENT FREQUENTLY PRESENT ALEXITHYMIA OVER FATIGUE, ANXIETY, AND DEPRESSION, DESPITE LOW DISEASE ASSESSMENT PARAMETERS
Authors: M. S. Nicoli, G. Tarantino, E. Marasco, E. Betti, M. F. Paniccia, T. Grimaldi, A. Aquilani, R. Nicolai, F. De Benedetti, S. Magni-Manzoni
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Psychological factors influence quality of life, disease perception, engagement and adherence to treatment in patients with Juvenile Idiopathic Arthritis (JIA). While anxiety and/or depression have been often documented in JIA, alexithymia has been seldom investigated. <h3>Objectives</h3> 1.To investigate the frequency of psychic symptoms in JIA patients at a single tertiary care center, including depressive, anxiety and alexithymic symptoms. 2.To investigate correlation between psychic symptoms and demographic and clinical parameters. <h3>Methods</h3> JIA patients aged 8-17 years and consecutively seen from March to November 2022 were invited to undergo psychological standardized tests: the Patient Health Questionnaire-9 items (PHQ9), self-administered measure of depressive symptoms; the Generalised Anxiety Disorder (GAD7) test; the Self-administered Psychiatric Scales for Children and Adolescents anxiety-related areas (SAFA-A), depression-related areas (SAFA-D) and somatic areas (SAFA-S); the PedsQL™ Multidimensional Fatigue Scale; PedsQL™ Rheumatology Module Pain and Hurt; the Toronto Alexithymia Scale (TAS-20); the Visual Analogue Scale (VAS) for pain intensity. Demographic data, clinical and laboratory parameters for disease assessment on the same visit were also recorded. Data were analyzed with descriptive statistics. Categorical data were represented as counts and percentages, while continuous data were represented as means and standard deviations or medians and ranges. Data were checked for normality. For normally distributed data, appropriate parametric statistical testes were employed, for non normally distributed data, non-parametric statistical tests were employed. Comparison in the frequency of the psychological symptoms in presence/absence of pain, active, painful/tender or limited joints was assessed. Significant level was set at p&lt;0.05. All statistical analyses were performed using R (version R 4.0.3). <h3>Results</h3> Thirty-seven JIA patients were enrolled in the study: 64.9% were females, 38% with persistent oligoarthritis, 22% extended oligoarthritis and 40% polyarthritis, and 32% with chronic uveitis ever. Median age was of 12.6 years (IQR 9.3-15.3), with a median disease duration of 5.5 years (IQR 3.6-7.6). Respectiveley, 96% and 95% of patients were receiving csDMARDS and bDMARDS. All disease parameters showed very low level of disease activity and disability. PHQ9 and GAD7 were pathologic in 41% and 44%, respectively; borderline or clinically pathologic scores were found in 27%, 29%, and 13% for SAFA-D, SAFA-A, SAFA-S, respectively. Of note, TAS-20 was borderline or pathologic in 32% of patients. No psychic symptoms, demographic variables or clinical features showed an association with disease parameters. No significant differences were found between patients with and without pain on VAS, active joints, painful/tender or limited joints. <h3>Conclusion</h3> In a selected cohort of JIA patients on intensive treatment, low disease activity and few limited joints psychological parameters for depression and anxiety were detectable in a sizable proportion; a higher percentage of patients reported fatigue; alexithymia was even more frequent, regardless disease assessment variables. Our findings support the rationale for adopting routine psychological assessment and intervention in JIA patients, and for extending psychological investigations to their parents/guardians. <h3>References</h3> [1]Fair DC. Open Access Rheumatol 2019;11:237–52 doi: 10.2147/OARR.S174408 [2]Bano S. Cureus 12: e6807 doi: 10.7759/cureus.6807 [3]Cobham VE. J Am Acad Child Adolesc Psychiatry 2020;59:595–618 doi: 10.1016/j.jaac.2019.10.010 [4]Badarnee M. J Psychol 2022;63:624-633 doi: 10.1111/sjop.12839 <h3>Acknowledgements</h3> Acknowledgements to Aurora Pucacco, HRP at the Rheumatology Division of the IRCCS Bambino Gesù Children's Hospital, for her logistic support during the study and daily care of JIA patients and families. <h3>Disclosure of Interests</h3> None declared.